- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.45 / $218.41 / $616.28
| Professional | | $116.45 | $218.41 | $616.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.27 / $469.48 / $1,008.13
| Professional | | $398.27 | $469.48 | $1,008.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.84 / $267.83 / $457.02
| Professional | | $159.84 | $267.83 | $457.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.19 / $267.83 / $454.83
| Professional | | $107.19 | $267.83 | $454.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.58 / $356.85 / $1,082.43
| Professional | | $289.58 | $356.85 | $1,082.43 |